Achilles tendon bursitis, or retrocalcaneal bursitis, can affect anyone, but is typically a foot condition in athletes, especially runners. Because of similar symptoms, this condition is often
confused with Achilles tendinitis. At times, bursitis of the Achilles tendon can occur in conjunction with Achilles tendinitis. When both conditions are present, it is referred to as Haglund's
syndrome. If you are a runner and are experiencing pain in your lower leg and heel area, you may be suffering from Achilles tendon bursitis. Proper treatment of the condition can help relieve the
pain and allow your leg to heal.

Causes

Pain at the posterior heel or ankle is most commonly caused by pathology at either the posterior calcaneus (at the calcaneal insertion site of the Achilles tendon) or at its associated bursae. Two
bursae are located just superior to the insertion of the Achilles (calcaneal) tendon. Anterior or deep to the tendon is the retrocalcaneal (subtendinous) bursa, which is located between the Achilles
tendon and the calcaneus. Posterior or superficial to the Achilles tendon is the subcutaneous calcaneal bursa, also called the Achilles bursa. This bursa is located between the skin and posterior
aspect of the distal Achilles tendon. Inflammation of either or both of these bursa can cause pain at the posterior heel and ankle region.

Symptoms

Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to
the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise the arm out from the side of
the body. Putting on a jacket or combing the hair becomes a troublesome activity. In acute bursitis symptoms appear suddenly, with chronic bursitis, pain, tenderness, and limited movement reappear
after exercise or strain.

Diagnosis

Like all other forms of bursitis, initially the physician will take down the history of symptoms experienced by the patient, this will be followed by a detailed physical examination which involves
checking for inflammation signs like pain, redness, and warmth of the heel area. The physician might examine further by moving the ankle a little to determine the exact location of pain. Further
diagnostic tests including x-ray, bone scans, and MRI scan might be suggested if required.

Non Surgical Treatment

Most bursitis cases can be treated by the patient without having to see a doctor. A trip to a pharmacy, a conversation with the pharmacist, and some self-care techniques are usually enough. The NHS
(National Health Service, UK) recommends PRICEM, a self-care management approach. PRICEM stands for Protection. Rest. Ice. Compression. Elevation. Medication. Protect the affected area, Some people
place padding to protect the affected bursae from any blow. Rest. Do not exercise or use the joints in the affected area unless you really have to. Let it rest. Bursitis is a condition that responds
well to rest. Ice packs. Ice packs can help reduce pain and inflammation. Make sure you do not place the ice directly on the skin, use a pack or towel. A small pack of frozen vegetables are ideal.
Raise the affected area. If you can, lift the affected area, raise it, less blood will gather there. This may help reduce the inflammation. Painkillers. Ibuprofen is an effective painkiller for
treating pain, it also reduces inflammation. Steroids. For more severe symptoms the doctor may inject steroids into the affected area. Steroids block a body chemical called prostaglandin.
Prostaglandin causes inflammation. Steroids may raise the patient's blood pressure if used for too long, as well as increasing his/her risk of getting an infection. UK doctors are advised not to give
more than three steroid injections in one year. Antibiotics. If the fluid test confirms that there is a bacterial infection, the doctor will probably prescribe antibiotics. These will be administered
orally (via mouth).

Surgical Treatment

Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for retrocalcanel bursitis can include many different procedures. Some of these include removal of the
bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone
is a primary cause of the bursitis, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and
correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the
problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.

Hammertoe is a condition in which the toes of your feet become contracted into an upside-down "V" shape, causing pain, pressure and, often, corns and calluses. hammertoes can develop on any of the toes, but generally affects the middle three toes, most often
the second toe. The bones, muscles, ligaments and tendons of your feet normally are well-balanced to distribute your body's weight while standing, walking and running. When the first and second
joints of your toes experience the prolonged stress that develops when the muscles that control them fail to work together properly, the pressure on the tendons that support them can lead to the
curling or contraction known as hammertoe.

Causes

While there are a number of causes, there aren't many specific risk factors for hammertoes, women tend to get these problems more than men, but they occur without rhyme or reason. Diabetics, however,
are more likely to get a hammertoe if they have underlying nerve damage in the toes and feet.

Symptoms

The symptoms of a hammer toe include the following. Pain at the top of the bent toe upon pressure from footwear. Formation of corns on the top of the joint. Redness and swelling at the joint
contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.

Diagnosis

A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.

Non Surgical Treatment

If the toes are still mobile enough that they are able to stretch out and lay flat, the doctor will likely suggest a change of footwear. In addition, she may choose to treat the pain that may result
from the condition. The doctor may prescribe pads to ease the pain of any corns and calluses, and medications ranging from ibuprofen to steroid injections for the inflammation Hammer toe and pain. Other options for non-surgical treatments include
orthotic devices to help with the tendon and muscle imbalance or splinting to help realign the toe. Splinting devices come in a variety of shapes and sizes but the purpose of each is the same: to
stretch the muscles and tendon and flatten the joint to remove the pain and pressure that comes from corns.

Surgical Treatment

Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus
relieving pain. Severe hammertoes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks
following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.

hammertoes most commonly affects the second toe on the foot. It causes the
middle joint to bend. Hammertoe is most frequently caused by structural problems in the toe or from wearing poor fitting shoes. It is important to diagnose and treat hammertoe early because the
condition tends to become worse over time. If left untreated, hammertoe can require surgery.

Causes

Most hammertoes are caused by wearing ill-fitting, tight or high-heeled shoes over a long period of time. Shoes that don't fit well can crowd the toes, putting pressure on the middle toes and causing
them to curl downward. The condition may be more likely when the second toe is longer than the first toe or when the arch of the foot is flat. Hammertoe can also be present at birth (congenital).
Hammertoe also can be caused by a bunion, which is the knobby bump that sometimes develops at the side of the big toe. A bunion causes the big toe to bend toward the other toes. The big toe can then
overlap and crowd the smaller toes. Occasionally, a hammertoe is inherited or caused by arthritis in the toe joint.

Symptoms

Hammer, claw, and mallet toes can cause discomfort and pain and may make it hard to walk. Shoes may rub on your toes, causing pain, blisters, calluses or corns, or sores. Sores can become infected
and lead to cellulitis or osteomyelitis, especially if you have diabetes or peripheral Hammer toes arterial
disease. If you have one of these health problems and sores develop, contact your doctor.

Diagnosis

First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a
metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in
the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.

Non Surgical Treatment

If the problem is caught in the early stages you can avoid hammer toe surgery. One of the easiest methods of treatment is to manipulate the toe out of a bent position then splint and buddy wrap it
alongside it?s larger neighbour. This method of hammer toe taping will help the problem to fix itself. Make sure the toe isn?t resuming its bent shape during the recovery. To alleviate some of the
painful symptoms of hammer toe avoid wearing high heels or shoes that cramp or stifle your feet. Choosing a pair of minimalist shoes can be an excellent choice for both foot and postural health.
Wearing shoes that give the toes plenty of space and are comfortable lined is also a smart choice. Hammer toe recovery starts be treating the toe respectfully. Soft insoles or protection for the corn
can also provide additional assistance.

Surgical Treatment

Surgery to straighten the toe may be needed if an ulcer has formed on either the end or the top surface of the toe. Surgery sometimes involves cutting the tendons that support movement in the toe so
that the toe can be straightened. Cutting the tendons, however, takes away the ability to bend the very end of the toe. Another type of surgery combines temporary insertion of a pin or rod into the
toe and alteration or repair of the tendons, so that the toe is straightened. After surgery, the deformity rarely recurs.

Over-pronation, or flat feet, occurs in the walking process when a person?s arch collapses upon weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, possibly
causing severe discomfort and leading to other foot problems. Bear in mind that people with flat feet often do not experience discomfort immediately, and some never suffer from any discomfort at all.
Over-pronation can often lead to conditions such as plantar fasciitis, heel spurs, metatarsalgia, post-tib tendonitis, bunions.

Causes

Flat feet don't automatically mean you have a problem. The problem can be divided into a flexible flat foot or rigid flat foot. The rigid flat foot is one that does not change shape when the foot
becomes weight bearing. i.e. it does not go through the excessive motion of pronation. Generally speaking this foot does not provide too many problems. The flexible flat foot is the type that when it
becomes weight bearing the foot and ankle tends to roll in (pronates) too far. This type of person will often say I have great arches but when I stand up much of this arch disappears as the foot
excessively pronates When the foot is excessively pronating and causing problems like sore ankles, feet or knees when standing or exercising then arch support is extremely important to restore the
foot structure.

Symptoms

Symptoms can manifest in many different ways. Here is a list of some of the common conditions associated with over-pronation in children. Achilles Pain. Ankle pain. Arch Pain. Low back pain. Heel
Pain. Knee Pain (Runner's knee and Chondromalecia of the patella) Osgood Schlatter Disease (pain below the knee) Shin Splints (pain in the front of the lower leg) Over-pronation does not necessarily
mean your child has "flat feet." Even though children's arches may be relatively high when they lie down or sit, over-pronation may not be seen until your child is standing. A certain amount of
pronation is normal. During normal walking or running ("gait cycle"), the heel strikes the ground and the foot rolls inward to absorb shock and adapt to the surface. This gait cycle is even more
important if the running surface is uneven.

Diagnosis

One of the easiest ways to determine if you overpronate is to look at the bottom of your shoes. Overpronation causes disproportionate wear on the inner side of the shoe. Another way to tell if you
might overpronate is to have someone look at the back of your legs and feet, while you are standing. The Achilles tendon runs from the calf muscle to the heel bone, and is visible at the back of the
ankle. Normally it runs in a straight line down to the heel. An indication of overpronation is if the tendon is angled to the outside of the foot, and the bone on the inner ankle appears to be more
prominent than the outer anklebone. There might also be a bulge visible on the inside of the foot when standing normally. A third home diagnostic test is called the ?wet test?. Wet your foot and
stand on a surface that will show an imprint, such as construction paper, or a sidewalk. You overpronate if the imprint shows a complete impression of your foot (as opposed to there being a space
where your arch did not touch the ground).

Non Surgical Treatment

One of the best forms of treatment for over pronation is wearing supportive shoes. Shoes should have ample support and cushioning, particularly through the heel and arch of the foot. Without proper
shoes, there may be additional strain on the tissue in the foot, greatly contributing to or causing an occurrence of over pronation. Rarely is surgery considered to relieve the pain and damage that
may have resulted from this condition. Orthotic shoe inserts are often the easiest and most effective way to correct pronation.

Surgical Treatment

Calcaneal "Slide" (Sliding Calcaneal Osteotomy) A wedge is cut into the heel bone (calcaneus) and a fixation device (screws, plate) is used to hold the bone in its new position. This is an aggressive
option with a prolonged period of non-weightbearing, long recovery times and many potential complications. However, it can and has provided for successful patient outcomes.

The true name of this complaint is calcaneal apophysitis which just means an inflamation of the growth centre of the bone in your heel as a result of pulling by the Achilles tendon - it is important
to realise that it is not a disease but rather a condition that develops in the growing skeleton with activity. It is the most common cause of heel pain in young athletes, and is the second most
common condition of its kind in the younger athelete after Osgood-Schlatter's disease. It is often seen at a time of rapid growth during which the muscles and soft tissues become tighter as the bones
get longer. It occurs more in boys than girls and is seen most commonly between the ages of 8 and 14 years though it tends to be more prevalent in the younger of this group.

Causes

Sever?s disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with
starting a new sport, or the start of a new season. Children who are going through adolescence are also at risk of getting it because the heel bone grows quicker than the leg. Too much weight bearing
on the heel can also cause it, as can excessive traction since the bones and tendons are still developing. It occurs more commonly in children who over-pronate, and involves both heels in more than
half of patients.

Symptoms

The symptoms of Sever?s Disease may vary but usually include generalised pain and discomfort around the back of the heel. Can be one sided or both sides. Starts after child starts a new sport season.
May cause child to limp due to pain. Increases with weight bearing activity. Heel becomes red and can be swollen. X-rays are usually inconclusive and simply show the growth plate.

Diagnosis

A Podiatrist can easily evaluate your child?s feet, to identify if a problem exists. Through testing the muscular flexibility. If there is a problem, a treatment plan can be create to address the
issue. At the initial treatment to control movement or to support the area we may use temporary padding and strapping and depending on how successful the treatment is, a long-term treatment plan will
be arranged. This long-term treatment plan may or may not involve heel raises, foot supports, muscle strengthening and or stretching.

Non Surgical Treatment

Please realize that the disorder may last only a couple of weeks to as long as 1-2 years. The treatment plan as prescribed by your doctor MUST be adhered to closely, and the activity level of the
child must be controlled during the early stages of treatment. All jumping and running sports, such as basketball, trampoline, volleyball, tennis, soccer, etc., must be eliminated as part of the
initial treatment. Once the child has improved and the pain has subsided, a rigid stretching program must then be implemented.

Exercise

The following exercises are commonly prescribed to patients with Severs disease. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally,
they should be performed 1 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and
eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no
increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed
around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate
stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Calf Stretch with Towel. Begin this
exercise with a resistance band around your foot and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable
without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free. Once you can perform 20 repetitions consistently
without pain, the exercise can be progressed by gradually increasing the resistance of the band provided there is no increase in symptoms. Bridging. Begin this exercise lying on your back in the
position demonstrated. Slowly lift your bottom pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for
2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.